Puzzle Solver

I am back on the hospital side again for work.  This change really only amounts to longer hours and sicker patients. 

It is rare in my job to really come across patients with mystery problems. I’d say 90% of the people who come into the hospital or clinic have names for their problems- they have heart failure, or pneumonia. They know they have gout, or liver failure.  If there is any doubt, usually the ER docs label the patients for us.  It’s a shame, because I love solving mysteries.  I think a reason I went into medicine was because I thought I would be putting complex puzzle pieces together to figure stuff out.  This, again, doesn’t happen that often.

Yesterday I had such a “puzzle”.  This pale 50 year old woman hadn’t been to a doctor in years. She was admitted for anemia, with a HGb of 5.5 (VERY LOW).  The work up began, as I thought through reasons and ordered tests.  All day I was absorbed, as tests started coming back very unusual.  I was investigating, and solving riddles, and I was loving it.  One of the abnormalities was gross blood in this patients urine.  Tho she hadn’t noticed anything, this was an ominous sign.  Immediately, I ordered a CT scan, to look at her bladder and kidneys. While other tests were indicating she was hemolyzing her blood (chewing up the cells) AS well as having trouble making cells with a bone marrow problem, this blood in the urine couldn’t be good.  The CT scan came back late last night.  With no radiologist around to officially read the scan, I took a preliminary read.  I was shocked as I saw what used to be a kidney, now 4 times normal with definite tumor.  Then the liver, studded with cancer, and the lungs full as well. 

My game, of solving puzzles, suddenly wasn’t as exciting anymore. I think I had expected discovering the cause of her problems and fixing her; feeling delight in the fact that all the hours spent studying and learning would pay off in helping someone.  It was as if my treasure hunt had turned up, not a treasure, but a trap or a dreadful poison or something harmful.  Yes, I got an answer, but now I had to go sit with this woman, who had assumed she came in to get some transfusions, and tell her that she had a very bad cancer that had already ravaged her whole self. 

I guess, being someone who likes to discover new things, I must be prepared for these situations. If you go turning over stones, you must realize that there are very bad things that live there.  

This is my patient’s actual CT showing the tumor, quite impressive!

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